Journey through Medical School: Darkness behind Bright Futures?

The teenage inclination to wear the white lab coat in a chemistry lab and pretend to be a doctor amidst friends implants in some hearts the irrepressible desire to take up that white coat for life time and step into the noble profession. However, the real journey filled with challenges of being a medical student begins after completion of Intermediate /A-levels when a person opts for medicine and enters a medical college. The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions.

However, some aspects of training may have unintended negative effects on medical students’ mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. Wartman described four major challenges facing the field of health professions education: conceptual difficulties, pressures on the curriculum, financial concerns, and the need to link education to outcomes. However, there are more challenges that a medical student faces such as adjustment to the medical school environment, ethical conflicts and student abuse.

I am going to discuss some of the challenges that medical students face once they enter any medical college. Medical students experience substantial stress from the beginning of the training process. Although some degree of stress is a normal part of medical training and can be a motivator for some individuals but not all students find stress constructive. For many individuals, stress arouses feelings of fear, incompetence, uselessness, anger, and guilt and can be associated with both psychological and physical morbidity.

In our culture, parents have very high expectations of their kids. If you’re doing well, they say ‘do better’ as a result of which a medical student works day and night to meet their parents’ expectations. Medical students right from the beginning compare the results with each other. Everybody in the class turns out to be a competitive master.

When one fails and the other passes; there is an automatic division between those who study well, who study average and who do not seem to care anymore. Those who do not meet their parents’ expectations eventually feel humiliated and come up with statements like “I don’t feel like studying. I don’t want to be a medical student” and medical education seems to be a Herculean task to them. The first-year medical student is faced with the challenges of being aloof from family and friends and adapting to a demanding new learning environment.

Human cadaver dissection is a well-recognized stress for many students, but other sources of distress, such as a substantially increased scholastic workload and concern for academic performance also characterize this transition. Attempting to master a large volume of information and joining a peer group of equal motivation and intelligence can be intimidating for young adults accustomed to rapid mastery of material and academic distinction. This challenge is amplified for students who struggle academically. High-stakes examinations that are university examinations must be passed before academic advancement also contribute to performance anxiety.

At the start of medical school, medical students have mental health similar to their nonmedical peers. Given that the aims of medical training include teaching graduates how to “promote health” and prepare for a career in an intellectually stimulating and socially meaningful profession, it is tempting to speculate that medical school would be a time of personal growth and enhanced health. Unfortunately, the contrary appears to be true, with numerous studies suggesting that students’ mental health worsens during medical school. Surveys in both the United States and elsewhere identify a high frequency of depression among medical students.

The depression is a biggest challenge faced by medical students because in addition to coping with the normal stressors of everyday life, medical students have to deal with stressors specific to medical school. In a study from Pakistan approximately 70% of the students had depression and it is consistent with another study conducted on medical students of a private university of Karachi. Another study from the United Kingdom and other countries found that the incidence of poor mental health doubled during the first year. Similarly, in a 2002 survey of first- and second-year US medical students, 24% of students were depressed according to the Beck Depression Inventory.

Verbal abuse is a common challenge, assignment of inappropriate task (that is, getting food for the team), physical abuse, sexual harassment and racial discrimination are also serious challenges faced by a medical student during the clinical years. The effect of abuse on students is serious. In one study of more than 500 medical students, more than 40% reported that they had personally experienced abuse with many stating that the experience was a major source of stress that affected them for a month or longer . Regardless of year in training, verbal abuse seriously affects students’ confidence and negatively affects the learning environment. These days, medical education is not easy and private sector charges cannot be easily borne by everyone.

Student debt has increased out of proportion to the escalation of tuition fees in recent years. Medical students resort to debts and the tension to repay keeps lingering in their minds and becomes one of the leading challenges faced by them.

These were some of the challenges faced by the medical students of today; however, these challenges eventually lead to multiple consequences like impaired academic performance, substance abuse as exemplified by alcohol consumption and suicide. Hence, we need to intervene timely and address these issues and sort them out to our maximum capability.

About the Author: Muhammad Yusuf Hafiz, is a second year medical student at Dow Medical College (DOW UNIVERSITY OF HEALTH SCIENCES) located in Karachi, Pakistan. He is an avid reader of Medical Journals and interested in becoming a neurosurgeon. Yusuf can be reached at [email protected]

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